The three areas of OCD research are: Suicide Risk in the Medical Setting Suicide is an international public health threat. In the U.S., it is the 2nd leading cause of death for youth and the 10th leading cause of death for adults. As suicide risk screening becomes a national priority for medical settings, non-mental health clinicians require valid, psychometrically-sound screening instruments for assessing suicide risk. However, there are very few such mental health assessment instruments that have been validated empirically with medically ill patients in hospital settings. Recognizing this gap early and capitalizing on clinical and research expertise within our group, we began developing a risk of suicide screen for pediatric patients in the emergency room in 2008 which resulted in a validated tool, the ASQ (Ask Suicide Screening Questions). The ASQ has been translated into Spanish, French, Dutch and Chinese and is currently being implemented in emergency departments in the U.S. and abroad. The tool is available on the NIMH website at www.nimh.nih.gov/news/science-news/ask-suicide-screening-questions-asq.shtml for public use. Since the development of the ASQ, the focus of our ongoing suicide screening studies has been to develop and validate brief screening instruments that can be administered by non-mental health clinicians in other medical settings and with specific patient populations. We currently have 5 IRB-approved protocols addressing suicide screening in different medical settings (NCT00623493, NCT01517126, NCT02140177, NCT02050867, NCT02830334). We are addressing areas of need, including pediatric and adult emergency department patients, and pediatric and adult medical inpatients. Our research is current with the February 2016 Joint Commission (JC) Sentinel Event Alert calling for suicide risk screening of all medical patients in a hospital setting and is consistent with NIMH's commitment to join with the National Action Alliance for Suicide Prevention to reduce the suicide rate by 20% over the next 5 years. In addition, our research team is working closely with NIH CC leadership in order to meet the JC recommendations; we are utilizing our research to inform implementation of suicide risk screening at the NIH CC and hospitals nationwide. Mental Health Aspects of Coping with Chronic Medical Illness Born out of our clinical work on the PCLS and neurocognitive assessment service for the past decade, a natural research focus has emerged from our collaborative work with other Institutes at NIH. For example, working with the Pediatric Oncology Branch we began to study distress and its correlates in medically ill children, particularly those with life-limiting illnesses, through 3 protocols over the past 5 years (NCT00824278, NCT00969579, NCT02423031). The collaboration has been highly productive leading to the development of the first advance care planning guide for adolescents and young adults with life-limiting illnesses, Voicing My CHOiCES www.agingwithdignity.org/forms/voicingmychoices.pdf. This planning guide is available at www.agingwithdignity.org Another study along these lines (NCT01778478) focuses on how to screen and diagnose psychiatric disorders in young adults (ages 18-25) with and without cancer. The study examines the feasibility of using the structured psychiatric diagnostic interview, Kiddie-Schedule for Affective Disorders and Schizophrenia Present and Lifetime version (K-SADS-PL), in this age group and evaluates whether the parent interview affects diagnostic findings. In addition, the study assesses psychosocial developmental milestone acquisition among young adult cancer patients compared to their healthy peers. Neuropsychiatric Aspects of Immune and Infectious Disorders (including HIV/AIDS), Genetic, and other Disorders The OCD Neuropsychology Unit is involved in a broad range of research protocols that are studying cognitive and emotional functioning in various diagnostic groups. These research protocols include genetic disorders (such as Mobius syndrome, methylmalonic academia, Cerebral Autosomal Dominant Arteriopathy with Sub-cortical Infarcts and Leukoencephalopaghy (CADASIL)), infectious and immune diseases (HIV, progressive multifocal leukoencephalopathy, Ebola, anti-NMDA receptor encephalitis), brain tumor (re-irradiation effects), and chronic fatigue syndrome. A large focus of these neuropsychiatric studies is HIV/AIDS. HIV-related research activities in the OCD fall into two categories: 1) NIH Intramural NeuroHIV Program, and 2) Collaborations with multi-site research networks, including an NIH DoD HIV/AIDS associated neurocognitive disorder protocol. In 2008 the NIH, led by NIAID, initiated a partnership with the District of Columbia (DC) government with the goal of reducing the impact of HIV on DC, which had almost a 3% prevalence rate of HIV infection, the highest of any city in the US. The program was also created to develop research infrastructure in the city to generate knowledge and change public policy as well as to develop research across NIH. In alignment with the NIMH's commitment to reduce the burden of mental illness in the HIV/AIDS population, NIMH, NINDS and NIAID have developed 2 intramural protocols (NCT01875588; NCT01692236) investigating HIV-related neurocognitive disorders, which are a clinical challenge and threat to the long-term health of people living with HIV/AIDS. In addition, we have worked to assess the mental health needs of HIV patients and build an interdisciplinary approach to HIV and mental health in DC, leading to funded projects being initiated at other DC institutions.
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